1
|
Li S, Tian A, Wen Y, Gu W, Li W, Qiao X, Zhang C, Luo X. FGD1-related Aarskog-Scott syndrome: Identification of four novel variations and a literature review of clinical and molecular aspects. Eur J Pediatr 2024; 183:2257-2272. [PMID: 38411716 PMCID: PMC11035466 DOI: 10.1007/s00431-024-05484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
Patients with Aarskog-Scott syndrome (AAS) have short stature, facial anomalies, skeletal deformities, and genitourinary malformations. FYVE, RhoGEF, and PH domain-containing 1 (FGD1) is the only known causative gene of AAS. However, the diagnosis of AAS remains difficult, and specific treatments are still absent. Patients suspected with AAS were recruited, and clinical information was collected. Genetic testing and functional analysis were carried out for the diagnosis. By literature review, we summarized the clinical and genetic characteristics of FGD1-related AAS and analyzed the genotype-phenotype correlation. Five patients were recruited, and four novel FGD1 variants were identified. The diagnosis of AAS was confirmed by genetic analysis and functional study. Three patients treated with growth hormone showed improved heights during the follow-up period. By literature review, clinical features of AAS patients with FGD1 variants were summarized. Regarding FGD1 variations, substitutions were the most common form, and among them, missense variants were the most frequent. Moreover, we found patients with drastic variants showed higher incidences of foot and genitourinary malformations. Missense variants in DH domain were related to a lower incidence of cryptorchidism. Conclusion: We reported four novel pathogenic FGD1 variations in AAS patients and confirmed the efficacy and safety of growth hormone treatment in FGD1-related AAS patients with growth hormone deficiency. Additionally, our literature review suggested the crucial role of DH domain in FGD1 function. What is Known: • Aarskog-Scott syndrome is a rare genetic disease, and the only known cause is the variant in FGD1 gene. The typical clinical manifestations of AAS include facial, skeletal, and urogenital deformities and short stature. What is New: • We reported four novel FGD1 variants and reported the treatment of growth hormone in FGD1-related AAS patients. Our genotype-phenotype correlation analysis suggested the crucial role of DH domain in FGD1 function.
Collapse
Affiliation(s)
- Sujuan Li
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Anran Tian
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yu Wen
- Department of Pediatrics, The First People's Hospital of Urumqi, Urumqi, 830000, People's Republic of China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, People's Republic of China
| | - Wei Li
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Xiaohong Qiao
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Cai Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| |
Collapse
|
2
|
Bertucci E, Giulini S, Sighinolfi G, Benuzzi M, Lugli L. Prenatal ultrasound signs of Aarskog-Scott syndrome in a twin pregnancy: A case report. Int J Gynaecol Obstet 2024; 165:837-839. [PMID: 38217107 DOI: 10.1002/ijgo.15351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024]
Abstract
SynopsisWe describe the case of Aarskog‐Scott syndrome in a twin pregnancy with the prenatal finding of shortened fetal long bones.
Collapse
Affiliation(s)
- Emma Bertucci
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Simone Giulini
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giovanna Sighinolfi
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Martina Benuzzi
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| |
Collapse
|
3
|
Kollara L, Reiss SL, Singam S, Kellogg B. Velopharyngeal Characteristics in Aarskog-Scott Syndrome: A Case Report. Cleft Palate Craniofac J 2024; 61:892-896. [PMID: 36475306 DOI: 10.1177/10556656221141235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Aarskog-Scott syndrome (AAS), also known as facio-digito-genital syndrome, is a rare heterogenous syndrome characterized by facial dysmorphism, brachydactyly, and genetic abnormalities. Although severe craniofacial abnormalities have been reported in AAS, little is known about speech and resonance issues in AAS. Specifically, published data to date have only indicated reports of hypernasality associated with a cleft palate in AAS. This case report provides clinical and anatomic information surrounding hypernasal speech in the absence of an overt cleft palate in a patient with AAS.
Collapse
Affiliation(s)
- Lakshmi Kollara
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, Biionix Cluster, University of Central Florida, Orlando, FL, USA
| | - Samantha L Reiss
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Sreekara Singam
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Brian Kellogg
- University of Central Florida College of Medicine, Orlando, FL, USA
- Division of Plastic & Craniofacial Surgery, Nemours Children's Hospital, Orlando, FL, USA
| |
Collapse
|
4
|
Takahashi I, Noguchi A, Kondo D, Sato Y, Suzuki H, Yamada M, Kosaki K, Takahashi T. A novel missense variant of FGD1 disrupts critical cysteine residues of the FYVE domain in Japanese siblings with Aarskog-Scott syndrome. Clin Pediatr Endocrinol 2024; 33:39-42. [PMID: 38299177 PMCID: PMC10825652 DOI: 10.1297/cpe.2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/07/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Daiki Kondo
- Department of Pediatrics, Akita Kousei Medical Center, Akita, Japan
| | - Yoko Sato
- Department of Pediatrics, Hiraka General Hospital, Yokote, Japan
| | - Hisato Suzuki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Mamiko Yamada
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
5
|
Han X, Lu S, Gu C, Bian Z, Xie X, Qiao X. Clinical features, epidemiology, and treatment of Shwachman-Diamond syndrome: a systematic review. BMC Pediatr 2023; 23:503. [PMID: 37803383 PMCID: PMC10557232 DOI: 10.1186/s12887-023-04324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Shwachman-Diamond syndrome (SDS) is an autosomal recessive disease which results in inherited bone marrow failure (IBMF) and is characterized by exocrine pancreatic dysfunction and diverse clinical phenotypes. In the present study, we reviewed the internationally published reports on SDS patients, in order to summarize the clinical features, epidemiology, and treatment of SDS. METHODS We searched the WangFang and China National Knowledge Infrastructure databases with the keywords "Shwachman-Diamond syndrome," "SDS," "SBDS gene" and "inherited bone marrow failure" for relevant articles published from January 2002 to October 2022. In addition, studies published from January 2002 to October 2022 were searched from the Web of Science, PubMed, and MEDLINE databases, using "Shwachman-diamond syndrome" as the keyword. Finally, one child with SDS treated in Tongji Hospital was also included. RESULTS The clinical features of 156 patients with SDS were summarized. The three major clinical features of SDS were found to be peripheral blood cytopenia (96.8%), exocrine pancreatic dysfunction (83.3%), and failure to thrive (83.3%). The detection rate of SDS mutations was 94.6% (125/132). Mutations in SBDS, DNAJC21, SRP54, ELF6, and ELF1 have been reported. The male-to-female ratio was approximately 1.3/1. The median age of onset was 0.16 years, but the diagnostic age lagged by a median age of 1.3 years. CONCLUSIONS Pancreatic exocrine insufficiency and growth failure were common initial symptoms. SDS onset occurred early in childhood, and individual differences were obvious. Comprehensive collection and analysis of case-related data can help clinicians understand the clinical characteristics of SDS, which may improve early diagnosis and promote effective clinical intervention.
Collapse
Affiliation(s)
- Xue Han
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Shuanglong Lu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Changjuan Gu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Zhuli Bian
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Xiaotian Xie
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China
| | - Xiaohong Qiao
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China.
| |
Collapse
|
6
|
Liang Y, Wu H, He X, He X. Case Report: Aarskog-scott syndrome caused by FGD1 gene variation: A family study. Front Genet 2022; 13:932073. [PMID: 36051692 PMCID: PMC9424661 DOI: 10.3389/fgene.2022.932073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Aarskog-Scott syndrome is a rare genetic disorder characterized by short stature, abnormal facial features, and digital and genital deformities. FGD1 gene variation is the known cause of this disorder. This paper described a Chinese family study of Aarskog-Scott syndrome in which the main patients were two brothers. Then, the relationship between genotype and phenotype in Aarskog-Scott syndrome was investigated preliminarily. A new FGD1 gene variant was revealed in this study, providing insights into the link between phenotype and genotype variations in Aarskog-Scott syndrome as well as a foundation for its diagnosis and treatment.
Collapse
Affiliation(s)
- Yijia Liang
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical College, Beijing, China
| | - Honglin Wu
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiumei He
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiyu He
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiyu He,
| |
Collapse
|
7
|
Martin-Suarez S, Pagano V, Campanini F, Nania R, Costantino A, Pacini D. Aortic root aneurysm in a patient with Aarskog-Scott syndrome. J Card Surg 2022; 37:2897-2899. [PMID: 35703394 DOI: 10.1111/jocs.16684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
We present the case of a 69 years old man affected by Aarskog-Scott syndrome. He came to our attention for an aneurysm of the aortic root, with almost moderate aortic regurgitation; moderate mitral regurgitation was discovered during preoperative assessment. We performed a modified Bentall's procedure and mitral valve repair. A patent foramen ovale was closed. Aarskog-Scott syndrome is a complex developmental disorder, characterized by X-linked recessive hereditariness short stature, craniofacial abnormalities, hyperextension of the proximal interphalangeal joints, and genital malformations. Diagnosis is still a challenge, in light of various clinical pictures and features in common with other syndromes (i.e., Noonan, SHORT, and Robinow syndromes). It has been longly debated if cardiac surveillance is needed among the affected patients; it should be probably undertaken, in view of the higher incidence of congenital heart disease. Moreover, the presence of extremely flexible joints suggests the coexistence of a connective tissue disorder.
Collapse
Affiliation(s)
- Sofia Martin-Suarez
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Vincenzo Pagano
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesco Campanini
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Riccardo Nania
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonino Costantino
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS, S. Orsola Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
8
|
Bayat A, Krett B, Dunø M, Torring PM, Vissing J. Novel truncating variants in FGD1 detected in two Danish families with Aarskog-Scott syndrome and myopathic features. Am J Med Genet A 2022; 188:2251-2257. [PMID: 35388608 PMCID: PMC9321604 DOI: 10.1002/ajmg.a.62753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/13/2022] [Accepted: 03/19/2022] [Indexed: 11/09/2022]
Abstract
Aarskog–Scott syndrome (AAS) is a developmental disorder, caused by disease‐causing hemizygous variants in the FGD1 gene. AAS is characterized by dysmorphic features, genital malformation, skeletal anomalies, and in some cases, intellectual disability and behavioral difficulties. Myopathy has only been reported once in two affected siblings diagnosed with AAS. Only few adult cases have been reported. This article reports four adults with AAS (three male cases and one female carrier) from two unrelated Danish families, all males presented with variable features suggestive of myopathy. All four carried novel hemizygous pathogenic variants in the FGD1 gene; one family presented with the c.2266dup, p.Cys756Leufs*19 variant while the c.527dup; p.Leu177Thrfs*40 variant was detected in the second family. All males had some mild myopathic symptoms or histological abnormalities. Case 1 had the most severe myopathic phenotype with prominent proximal muscular fatigue and exercise intolerance. In addition, he had multiple deletions of mtDNA and low respiratory chain activity. His younger nephew, case 3, had difficulties doing sports in his youth and had a mildly abnormal muscle biopsy and relatively decreased mitochondrial enzyme activity. The singular case from family 2 (case 4), had a mildly myopathic muscle biopsy, but no overt myopathic symptoms. Our findings suggest that myopathic involvement should be considered in AAS.
Collapse
Affiliation(s)
- Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark.,Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Bjørg Krett
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Dunø
- Department of Clinical Genetics, Molecular Genetic Laboratory, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Zhu Y, Chen Q, Lin H, Lu H, Qu Y, Yan Q, Wang C. FGD1 Variant Associated With Aarskog-Scott Syndrome. Front Pediatr 2022; 10:888923. [PMID: 35911831 PMCID: PMC9329920 DOI: 10.3389/fped.2022.888923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aarskog-Scott syndrome, a rare X-linked genetic disorder, is identified by combined clinical manifestations of short stature, facial, skeletal, and genital anomalies. Annually, two or three new cases are diagnosed with Aarskog-Scott syndrome, which is associated with FGD1 variants. However, there is no specific treatment for Aarskog-Scott syndrome due to its unclear mechanism. METHODS Clinical data were collected when the patient first visited the hospital. Trio whole-exome sequencing and Sanger sequencing were performed for the genetic cause of disease. To evaluate the pathogenicity of the variants in vitro, stable cell lines were constructed using lentivirus infection in 143B cell. Furthermore, Western blot was used to verify the expression of signaling pathway-related proteins, and the transcription levels of osteogenic-related genes were verified by luciferase reporter gene assay. RESULTS A 7-year-old boy was manifested with facial abnormalities, intellectual disability, and short stature (-3.98 SDS) while the growth hormone level of stimulation test was normal. Trio whole-exome sequencing and Sanger sequencing identified a variant (c.1270A>G, p.Asn424Asp) in FGD1 gene. The Asn424 residue was highly conserved and the hydrogen bond in the FGD1 variant protein has changed, which led to decrease in the interaction with CDC42 protein. In vitro study showed that the Asn424Asp variant significantly decreased the transcription levels of OCN, COL1A1, and ALP activity, and it activated the phosphorylation of JNK1. CONCLUSION Molecular biological mechanisms between abnormal expression of FGD1and Aarskog-Scott syndrome remain poorly understood. In our study, c.1270A>G variant of FGD1 resulted in Aarskog-Scott syndrome, and the analysis of pathogenicity supports the deleterious effect of the variant. Furthermore, we demonstrated the weakened affinity of the mutant FGD1 and CDC42. Decreased expression of osteogenic-related gene and abnormal activation of JNK1 were also shown in this work.
Collapse
Affiliation(s)
- Yilin Zhu
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqing Chen
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Haiyan Lin
- Department of Pediatrics, The First People's Hospital of Wenling, Taizhou, China
| | - Huifei Lu
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yangbin Qu
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qingfeng Yan
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,College of Life Sciences, Zhejiang University, Hangzhou, China.,Key Laboratory for Cell and Gene Engineering of Zhejiang Province, Hangzhou, China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
10
|
Kessel I, German A, Peleg A, Gonzaga-Jauregui C, Paperna T, Ekhilevitch N, Kurolap A, Baris Feldman H, Sagi-Dain L. A novel truncating variant in the FGD1 gene associated with Aarskog-Scott syndrome in a family previously diagnosed with Tel Hashomer camptodactyly. Am J Med Genet A 2021; 185:3161-3166. [PMID: 34145742 DOI: 10.1002/ajmg.a.62401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022]
Abstract
Tel Hashomer camptodactyly syndrome is a long-known entity characterized by camptodactyly with muscular hypoplasia, skeletal dysplasia, and abnormal palmar creases. Currently, the genetic basis for this disorder is unknown, thus there is a possibility that this clinical presentation may be contained within another genetic diagnosis. Here, we present a multiplex family with a previous clinical diagnosis of Tel Hashomer camptodactyly syndrome. Whole exome sequencing and pedigree-based analysis revealed a novel hemizygous truncating variant c.269_270dup (p.Phe91Alafs*34) in the FGD1 gene (NM_004463.3) in all three symptomatic patients, congruous with a diagnosis of Aarskog-Scott syndrome. Our report adds to the limited data on Aarskog-Scott syndrome, and emphasizes the importance of unbiased comprehensive molecular testing toward establishing a diagnosis for genetic syndromes with unknown genetic basis.
Collapse
Affiliation(s)
- Irena Kessel
- Department of Neonatology, Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alina German
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrinology, Bnei Zion Medical Center, Haifa, Israel
| | - Amir Peleg
- Genetics Institute, Carmel Medical Center, Haifa, Israel
| | | | | | - Tamar Paperna
- The Genetics Institute, Rambam Health Care Campus, Haifa, Israel
| | - Nina Ekhilevitch
- The Genetics Institute, Rambam Health Care Campus, Haifa, Israel
| | - Alina Kurolap
- The Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lena Sagi-Dain
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Genetics Institute, Carmel Medical Center, Haifa, Israel
| |
Collapse
|